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An unusual cause of disabling angina following aortic valve replacement
H H Cheung1, W H Chow, C K Mok
1Department of Surgery, University of Hong Kong, Grantham Hospital.
Insights
Severe coronary ostial stenosis after aortic valve replacement can be fatal. Prompt prosthesis revision and patch angioplasty successfully treated a patient, restoring normal coronary anatomy and function.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Background:
- Severe ostial stenosis of coronary arteries is a rare but life-threatening complication post-aortic valve replacement (AVR).
- This condition often presents with angina, arrhythmias, heart failure, or sudden death.
- It is typically attributed to injury during aortic cannulation or cardioplegia delivery.
Observation:
- A patient developed critical left coronary ostial stenosis following AVR.
- The stenosis was likely caused by prosthesis oversizing and improper orientation.
- The patient presented with symptoms indicative of severe coronary obstruction.
Findings:
- Surgical intervention involved prosthesis replacement and patch angioplasty of the left coronary ostia.
- The patient experienced a successful outcome with no recurrence of stenosis.
- Coronary anatomy was normal three years post-procedure, indicating long-term efficacy.
Implications:
- This case highlights the importance of meticulous prosthesis selection and placement during AVR to prevent coronary complications.
- Prompt surgical management, including revision and angioplasty, can effectively treat coronary ostial stenosis.
- Successful management ensures favorable long-term outcomes and improved patient survival after AVR.
Abstract:
Severe ostial stenosis of the coronary arteries following aortic valve replacement is a potentially lethal complication. The usual presentations are recent onset of severe angina, ventricular arrhythmias, congestive heart failure, and sudden death. It is generally accepted to arise from injury to the coronary arteries during direct cannulation and continuous perfusion of cardioplegia under high pressure during operation. We report on a patient who developed critical left coronary ostial stenosis after aortic valve replacement. The cause for the stenosis was probably related to the over-sizing and orientation of the prosthesis. The prosthesis was replaced and patch angioplasty of the left coronary ostia performed. The patient was well with normal coronary anatomy three years after surgery.